自体腘绳肌腱重建前交叉韧带后肌腱再生的MRI研究  

MRI STUDY ON TENDON REGENERATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDON AUTOGRAFTS

作　　者：刘虎[1] 陈百成[1] 孙然[1] 闫昌葆[1] 朱超华[1] 谢磊[1] 王智慧[1] 

机构地区：[1]河北医科大学第三医院关节外科,石家庄050051

出　　处：《中国修复重建外科杂志》2011年第9期1090-1093,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的应用MRI观察半腱肌腱及股薄肌腱取材重建前交叉韧带(anterior cruciate ligament,ACL)后肌腱再生情况。方法对2007年9月-2009年9月,52例采用单侧自体半腱肌腱、股薄肌腱重建ACL患者进行研究。男29例,女23例;年龄19～42岁,平均31.6岁。左膝34例,右膝18例。损伤原因:交通事故伤11例,运动伤38例,重物砸伤2例,其他伤1例。伤后至手术时间为6d～31个月,中位时间为11.4个月。关节疼痛19例,关节不稳28例,关节肿胀5例。股部肌肉萎缩(双股部周径差>1cm)7例,关节活动部分受限2例。浮髌试验阳性5例,Lachman试验阳性51例,轴移试验阳性49例,前抽屉试验均为阳性。膝关节活动度为(127.77±5.73)°,Lysholm评分为(52.40±3.45)分,国际膝关节文献委员会(IKDC)评分为(49.50±4.08)分。合并内侧半月板损伤23例,外侧半月板损伤6例,滑膜皱襞2例,游离体1例。结果术后患者切口均Ⅰ期愈合。患者均获随访,随访时间12～18个月,平均14.9个月。术后12个月时前抽屉试验均呈阴性,Lachman试验阳性1例,轴移试验阳性1例。膝关节活动度为(131.91±1.81)°,Lysholm评分为(94.98±2.77)分,IKDC评分为(93.65±2.42)分,与术前比较差异均有统计学意义(P<0.05)。术后12个月,屈膝90°抗阻力试验检查显示39例腘窝内侧可见绷紧的组织条带;MRI检查提示:10例半腱肌腱及股薄肌腱均有再生,29例半腱肌腱再生、股薄肌腱未再生,2例半腱肌腱未再生、股薄肌腱再生,11例半腱肌腱及股薄肌腱均未再生。半腱肌腱再生率为75.0%(39/52),股薄肌腱再生率为23.1%(12/52),总半腱肌腱和股薄肌腱再生率为78.8%(41/52)。结论半腱肌腱及股薄肌腱取材重建ACL后MRI检查提示部分患者有肌腱再生现象。Objective To evaluate the tendon regeneration after anterior cruciate ligament（ACL） reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI.Methods Between September 2007 and September 2009,52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled.There were 29 males and 23 females with an average age of 31.6 years（range,19-42 years）.The left knees were involved in 34 cases and the right knees in 18 cases.The injury was caused by traffic accident in 11 cases,by sports in 38 cases,by heavy pound injury in 2 cases,and by other in 1 case.The time between injury and operation was 6 days to 31 months（median,11.4 months）.Joint pain occurred in 19 cases,joint instability in 28 cases,and joint swelling in 5 cases.The physical examination on admission showed thigh amyotrophy in 7 cases（thigh circumference side-to-side difference 〉 1 cm） and limitation of joint motion in 2 cases.The results of floating patella test,Lachman test,pivot shift test,and anterior drawer test were positive in 5,51,49,and 52 cases,respectively.The range of motion of knee was（127.77 ± 5.73）°,International Knee Documentation Committee（IKDC） score was 49.50 ± 4.08,and Lysholm score was 52.40 ± 3.45.Of the patients,23 were accompanied with medial meniscus tear,6 with lateral meniscus tear,2 with plica synovialis,and 1 with loose body.Results All incisions healed by first intention.All the patients were followed up 12-18 months（mean,14.9 months）.At 12 months postoperatively,the results of Lachman test and pivot shift test were positive in 1 case,respectively;the results of anterior drawer test were negative in 52 cases.The range of motion of knee was（131.91 ± 1.81）°,Lysholm score was 94.98 ± 2.77,IKDC score was 93.65 ± 2.42;and there were significant differences when compared with the preoperative ones（P 〈 0.05）.At 12 months postoperatively,at 90° resisted flexion of the knee,a very distinct fibrous band could be identified

关 键 词：前交叉韧带重建 半腱肌腱 股薄肌腱 腘绳肌腱 肌腱再生 MRI 

分 类 号：R687.2[医药卫生—骨科学]